A Difficult Pill to Swallow: An Investigation of the Factors Associated with Medication Swallowing Difficulties

Chandramouli Radhakrishnan, Aida Sefidani Forough, Julie A Y Cichero, Heather E Smyth, Aisha Raidhan, Lisa M Nissen, Kathryn J Steadman, Chandramouli Radhakrishnan, Aida Sefidani Forough, Julie A Y Cichero, Heather E Smyth, Aisha Raidhan, Lisa M Nissen, Kathryn J Steadman

Abstract

Background: Many medications are available as solid oral dosage forms such as tablets and capsules; however, some people find these medications difficult to swallow.

Aim: To identify whether certain psychological, oral sensory, and oral motor characteristics contribute to medication swallowing difficulties.

Methods: A sample of healthy adults from two academic institutions in Brisbane were assessed for their experiences with swallowing solid oral dosage forms, food preferences, and food neophobia. The gag reflex, oral cavity size, fungiform papillae count, and chewing efficacy were also evaluated followed by a capsule-swallowing task. Primary outcome was the incidence of medication swallowing difficulties. Secondary outcomes were the association of medication swallowing difficulties with psychological, oral sensory, and oral motor factors.

Results: Of 152 subjects, 32% reported difficulty swallowing tablets or capsules whole. This group was significantly more likely to have had a memory of choking on medications compared to those without medication swallowing difficulties (OR = 7.25, p < 0.05). Current medication swallowing difficulties were significantly associated with a smaller mouth cavity size (OR = 2.98, p < 0.05), a higher density of taste receptors on the tongue (OR = 3.27, p < 0.05), and were higher among those who chewed a jelly candy to non-homogenous particle size (OR = 4.1, p < 0.05). Current medication swallowing difficulties were associated with lower confidence in swallowing large capsules (000 size: OR = 0.47, 00 size: OR = 0.39, p < 0.05). No associations were found between medication swallowing difficulties and the gag reflex or food neophobia.

Conclusion: A combination of heightened oral perception characterized by a small oral cavity and high taste sensitivity compounded by a past choking episode on medications may be precipitating factors for medication swallowing difficulties. These factors may be helpful in identifying individuals who are more likely to experience difficulty swallowing medications.

Keywords: dysphagia; medication swallowing; oral dosage forms; swallowing difficulties; tablets.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2021 Radhakrishnan et al.

Figures

Figure 1
Figure 1
The recollection of an episode of choking on (A) medication (n = 152) or (B) food for participants reporting current having medication swallowing difficulties in comparison to those with no current medication swallowing difficulties (n = 149). Significant difference between bars in terms of the proportion of participants reporting current medication swallowing difficulties is indicated: *p < 0.05.
Figure 2
Figure 2
Mallampati classification of the oral cavity (A) and classification of fungiform papillae density (B) for participants with or without current medication swallowing difficulties. Participants were classified as having a large mouth cavity (Class I and II) or a smaller mouth cavity (Class III and IV) according to the modified Mallampati method (n=152), and as a supertaster, medium taster, and non-taster according to fungiform papillae density (n=134). Significant differences between bars in terms of the proportion of participants reporting current medication swallowing difficulties are indicated: **p < 0.01, *p < 0.05.
Figure 3
Figure 3
Particle size of bolus fragments after chewing a piece of a jelly snake (n = 152), for those with and without medication swallowing difficulties. Significant difference between bars in terms of proportion of participants reporting current medication swallowing difficulties are indicated: **p

Figure 4

The quantity of water used…

Figure 4

The quantity of water used to swallow a capsule (size 00) in subjects…

Figure 4
The quantity of water used to swallow a capsule (size 00) in subjects with and without medication swallowing difficulties (n = 148).
Figure 4
Figure 4
The quantity of water used to swallow a capsule (size 00) in subjects with and without medication swallowing difficulties (n = 148).

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